Pathologic complete response rates after neoadjuvant treatment in rectal cancer: An analysis of the NCDB.

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 713-713 ◽  
Author(s):  
Patrick D. Lorimer ◽  
Russell C. Kirks ◽  
Danielle Boselli ◽  
Anthony Joseph Crimaldi ◽  
Joshua S. Hill ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Neoadjuvant Therapy ◽  
Mixed Models ◽  
Generalized Linear Mixed Models ◽  
Linear Mixed Models ◽  
Pathologic Complete Response ◽  
High Volume ◽  
Complete Response ◽  
Lower Grade ◽  
T Classification

713 Background: Pathologic complete response (pCR) of rectal cancer following neoadjuvant therapy is associated with decreased local recurrence and increased overall survival. The present study utilizes a large national dataset to identify predictors of pCR in rectal cancer. Methods: The NCDB was queried for patients with non-metastatic rectal cancer (2004-2011) who underwent neoadjuvant therapy (regional radiation dose 4500 cGy, boost dose 540 cGy) followed by surgical resection. Generalized linear mixed models were used to analyze the probability of pCR by hospital volume with adjustments for demographic, socioeconomic, staging, and tumor characteristics. Hospitals were separated into groups based on the number of resections performed per year <2, 2-5, and 5+. To account for clustering of cases at individual hospitals, a random effect was used at the hospital level and covariates were included as fixed effects. Results: 7,859 patients met inclusion criteria from 951 participating hospitals. Generalized linear mixed models demonstrated that the odds of achieving pCR was independently associated with more recent diagnosis, female gender, private insurance, smaller tumor size, lower grade, lower clinical T-classification, increasing interval between the end of radiation and surgery, and treatment at higher volume institutions (Table). Conclusions: The incidence of pCR was associated with favorable tumor factors (size, grade, T classification), demographics (insurance status) as well as treatment factors (time between radiation and surgery and institutional volume). With the data available, it is not clear what is driving the higher rates of pCR at high volume institutions. Research specifically targeted at understanding processes which are associated with pCR in high volume institutions is needed so that similar results can be achieved across the spectrum of facilities caring for patients in this population. [Table: see text]

Normalization of CEA Levels Post-Neoadjuvant Therapy is a Strong Predictor of Pathologic Complete Response in Rectal Cancer

2015 ◽  
Vol 19 (6) ◽  
pp. 1106-1112 ◽  
Author(s):  
Ariella Kleiman ◽  
Ahmed Al-Khamis ◽  
Ali Farsi ◽  
Abbas Kezouh ◽  
Te Vuong ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Neoadjuvant Therapy ◽  
Strong Predictor ◽  
Pathologic Complete Response ◽  
Complete Response

Organ preservation in patients with rectal cancer with clinical complete response after neoadjuvant therapy.

2015 ◽  
Vol 33 (3_suppl) ◽  
pp. 509-509 ◽  
Author(s):  
Jesse Joshua Smith ◽  
Oliver S Chow ◽  
Anne Eaton ◽  
Maria Widmar ◽  
Garrett Michael Nash ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Neoadjuvant Therapy ◽  
Pathologic Complete Response ◽  
Neoadjuvant Treatment ◽  
Oncologic Outcome ◽  
Complete Response ◽  
Rank Test ◽  
Salvage Operation ◽  
Clinical Complete Response ◽  
Kaplan Meier

509 Background: Nonoperative management (NOM) of rectal cancer following a clinical complete response (cCR) to neoadjuvant therapy is a non-standard approach. We review our experience with NOM to evaluate safety and efficacy. Methods: A retrospective review of prospectively collected data between 2006 and 2014 was conducted. We compared patients completing neoadjuvant therapy for stage I to III rectal cancers who: a) achieved cCR and were treated with NOM, or b) underwent standard total mesorectal excision (TME) and achieved a pathologic complete response (pCR). Kaplan-Meier estimates and the log-rank test were used. Results: Seventy-three patients underwent NOM after cCR. From 369 rectal resections performed, 72 (20%) achieved pCR and form the comparison group. Median follow-up across both groups was 3.3 years. Rectal preservation was achieved in 56 (77%) of the patients treated with NOM. Of the 19 NOM patients with local regrowth, 18 were salvaged successfully with standard TME (n=16) or local excision (n=2), with one patient pending a salvage operation (n=1). No significant differences were noted in the number of distant recurrences between the NOM and pCR groups. Four-year disease-specific survival and overall survival between the two groups were not significantly different. Conclusions: In this highly selected group of patients with cCR to neoadjuvant treatment, NOM with surgical salvage of local tumor regrowth achieved local control in all patients. The oncologic outcome for NOM patients at 4 years was comparable to patients with pCR after rectal resection. These data continue to suggest that NOM does not compromise oncologic outcome, and that preservation of the rectum is achieved in a majority of patients. [Table: see text]

scholarly journals Survival landscape of different tumor regression grades and pathologic complete response in rectal cancer after neoadjuvant therapy based on reconstructed individual patient data

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jia-yi Li ◽  
Xuan-zhang Huang ◽  
Peng Gao ◽  
Yong-xi Song ◽  
Xiao-wan Chen ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Neoadjuvant Therapy ◽  
Individual Patient Data ◽  
Tumor Regression ◽  
Pathologic Complete Response ◽  
Disease Free Survival ◽  
Direct Calculation ◽  
Complete Response ◽  
Patient Data ◽  
Term Survival

Abstract Background Neoadjuvant therapy can lead to different tumor regression grades (TRG) in rectal cancer after neoadjuvant therapy. The purposes of this study are to investigate the relationships among TRG, pathologic complete response (pCR) and long-term survival, on the basis of reconstructed individual patient data (IPD). Methods The PubMed, Embase, Ovid and Cochrane CENTRAL databases were searched. The primary endpoint was to evaluate the survival landscape of different TRGs after neoadjuvant therapy and the secondary endpoint was to evaluate the associations between pCR and survival. IPD were reconstructed with Kaplan–Meier curves. Results The 10-year overall survival (OS) and 5-year disease-free survival (DFS) were clearly higher in the pCR group than in the non-pCR (npCR) group (80.5% vs. 48.3, 90.1% vs. 69.8%). Furthermore, the OS and DFS increased with improvement in tumor regression after neoadjuvant therapy. According to the IPD, the pCR group had longer OS (HR = 0.240, 95% CI = 0.177–0.325, p < 0.001) and DFS (HR = 0.274, 95% CI = 0.205–0.367, p < 0.001) than the npCR group. Better tumor regression was associated with better survival outcomes (p < 0.005). Direct calculation of published HR values yielded similar results. Conclusions Our results indicate a positive relationship between better tumor regressions and improved survival benefits among the npCR group and patients with rectal cancer achieving pCR had much longer OS and DFS than patients achieving npCR, presenting a survival landscape of different TRGs and pCR in rectal cancer after neoadjuvant therapy.

Do clinical criteria reflect pathologic complete response in rectal cancer following neoadjuvant therapy?

2018 ◽  
Vol 33 (6) ◽  
pp. 727-733 ◽  
Author(s):  
Aurelie Garant ◽  
Livia Florianova ◽  
Adrian Gologan ◽  
Alan Spatz ◽  
Julio Faria ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Neoadjuvant Therapy ◽  
Pathologic Complete Response ◽  
Complete Response ◽  
Clinical Criteria

CEA – A Predictor for Pathologic Complete Response After Neoadjuvant Therapy for Rectal Cancer

2013 ◽  
Vol 56 (7) ◽  
pp. 859-868 ◽  
Author(s):  
Ulrik Wallin ◽  
David Rothenberger ◽  
Ann Lowry ◽  
Russell Luepker ◽  
Anders Mellgren
Keyword(s):  
Rectal Cancer ◽  
Neoadjuvant Therapy ◽  
Pathologic Complete Response ◽  
Complete Response

scholarly journals Pathologic complete response implies a fewer number of lymph nodes in specimen of rectal cancer patients treated by neoadjuvant therapy and total mesorectal excision

2018 ◽  
Vol 56 ◽  
pp. 283-287 ◽  
Author(s):  
Leonardo Alfonso Bustamante-Lopez ◽  
Caio Sergio Rizkallah Nahas ◽  
Sergio Carlos Nahas ◽  
Carlos Frederico Sparapan Marques ◽  
Rodrigo Ambar Pinto ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Lymph Nodes ◽  
Total Mesorectal Excision ◽  
Neoadjuvant Therapy ◽  
Cancer Patients ◽  
Pathologic Complete Response ◽  
Complete Response ◽  
Mesorectal Excision

Complete neoadjuvant treatment for rectal cancer: A single institution experience.

2020 ◽  
Vol 38 (4_suppl) ◽  
pp. 148-148
Author(s):  
John Baekey ◽  
Robert Brunault ◽  
Howard Safran ◽  
Rimini Breakstone ◽  
Matthew Vrees ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Neoadjuvant Therapy ◽  
Clinical Stage ◽  
Pathologic Complete Response ◽  
Neoadjuvant Treatment ◽  
Complete Response ◽  
Preoperative Chemoradiation ◽  
Stage Ii ◽  
Routine Practice ◽  
Full Dose

148 Background: Full dose adjuvant chemotherapy following preoperative chemoradiation and surgery is poorly tolerated in stage II and III rectal cancer. We reviewed our institution’s experience with complete neoadjuvant treatment for rectal cancer since publication of the BrUOG R-224 trial results. Methods: After obtaining IRB approval, Data on patients with stage II and III rectal cancer who underwent complete neoadjuvant therapy were collected.. Patients who were planned to receive 8 cycles of modified FOLFOX6, chemoradiation with capecitabine 825 mg/m2 twice daily and 50.4 Gy intensity-modulated radiation therapy, then surgery were included. Results: Thirty-five patients were treated with complete neoadjuvant therapy between January 2014 and December 2017. Median age was 58 years (27 to 75 y); 1 patient (3%) was clinical stage II and 34 (97%) stage III. Twenty-seven patients (77%) received all 8 cycles of mFOLFOX6, of whom 24 completed subsequent chemoradiation. Therefore 69% of patients completed therapy according to the BrUOG R-224 protocol. Pathologic complete response (ypT0N0) was observed in 9 patients (26%). Treatment related toxicities resulted in dose reductions or treatment interruption in 57% and 29% of patients receiving chemotherapy and chemoradiation respectively. Conclusions: Complete neoadjuvant therapy for clinical stage II to III rectal cancer is well-tolerated in routine practice and offers an alternative to preoperative chemoradiation, surgery, then adjuvant full dose chemotherapy.

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